Case Study: Mat-Su Health Foundation

Improving outcomes in high-risk populations

Patients with high-risk behaviors need more than standard medical care can offer to address the underlying social determinants that impact overall health. By adopting a holistic community-based approach through CBCS, the LinksSocial Services program—funded by the Mat-Su HealthFoundation—achieved significant results in improving patient outcomes and bottom-line cost.

Background: Understanding the Social Determinants of Health

Social determinants of health have a significant impact on patient care, affecting an estimated two-thirds of patients and accounting for roughly 80% of a patient’s outcomes.

At the Mat-Su HealthFoundation in Wasilla, Alaska, external programs and partnerships were put in place and funded to help address these social determinants. In addition, because many of these patients had comorbid behavioral health diagnoses, special resources—including a behavioral health crisis intervention team—were made available to address comorbidities.

As patients frequented the emergency departments, they were referred to these additional services, but few patients followed through. As a result, providers and social workers found that patients were instead relying on 911 and emergency services rather than participating in the specialized programs and getting proper care at a lower acuity level.

Solution: Creating something better, together

Looking for a way to improve the effectiveness of community programs, the foundation partnered with Community Based Coordination Solutions (CBCS) to develop the High Utilizer Mat-Su (HUMS) program—a community collaborative program utilizing the CBCS Direct Patient Engagement program to support high-risk populations by bringing together medical, behavioral, and community resources to provide critical care and address social
determinants.

Download the full case study here to learn how by partnering with CBCS, Mat-Su achieved an average 57% reduction in ED utilization, a 47% reduction in opioid prescriptions, and over $4 million in savings over two years.

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